Hoarding Disorder: A new disorder in the draft of the DSM-V

The Diagnostic and Statistical Manual of Mental Disorders is currently under review by psychiatrists and other mental health professionals for its fifth edition (the DSM-V) before its official printing in 2013. Included in the draft of the DSM-V is a new section on Hoarding Disorder, listing hoarding as its own diagnosis separate from Obsessive-Compulsive Disorder.

The disorder is identified by five characteristics, the first three being:

A. Persistent difficulty discarding or parting with personal possessions, even those of apparently useless or limited value, due to strong urges to save items, distress, and/or indecision associated with discarding.

B. The symptoms result in the accumulation of a large number of possessions that fill up and clutter the active living areas of the home, workplace, or other personal surroundings (e.g., office, vehicle, yard) and prevent normal use of the space. If all living areas are uncluttered, it is only because of others’ efforts (e.g., family members, authorities) to keep these areas free of possessions.

C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning (including maintaining a safe environment for self and others).

The third point, that the hoarder is incapable of “maintaining a safe environment for self and others,” seems to be the dividing line between hoarding and chronic disorganization.

Hoarding also appears in multiple places in the document as a symptom of other disorders. According to the Hoarding Disorder entry in the DSM-V draft, hoarding can also be a symptom of Obsessive-Compulsive Disorder, Major Depressive Disorder, delusions in Schizophrenia or another Psychotic Disorder, cognitive deficits in Dementia, restricted interests in Autistic Disorder, and food storing in the Prader-Willi Syndrome.

I’m interested in following this topic to see if the proposed Hoarding Disorder ends up as a separate diagnosis in the final version of the DSM-V. Hoarding has appeared in previous versions of the DSM, but only as a symptom of other disorders. If it does make the final version, I hope that it helps people who are hoarders to get the quality treatment they need.

25 Comments for “Hoarding Disorder: A new disorder in the draft of the DSM-V”

  1. posted by Fred E. on

    I honestly don’t think it should be a free-standing psychiatric diagnosis because it’s more of a symptom or expression of other problems rather than a primary problem. It would be like making talking to one’s self a diagnosis instead of the underlying problem of schizophrenia, for instance.

  2. posted by Erin Doland on

    @Fred — In my non-medical opinion, I think that you’re right that hoarding is almost always a symptom of another disorder. However, from what I’ve read, there are some cases where it’s not a symptom of a greater issue. I think those are the people the new diagnosis is trying to identify. Since a DSM-V diagnosis is required by most insurance companies for treatment to be covered, I think this is the psychiatric community’s way of helping those people who don’t match up with any other diagnosis.

  3. posted by Micayla on

    Fred E.
    Have you had an experience with a TRUE hoarder? My grandmother doesn’t like to part with things-like cardboard- that she thinks may be useful, and as you are referring to, that is a symptom of something else- her insecurity stemming from living through the depression. The people referred to here are instead compelled to hoard things of no use for no reason, and it can be a compulsion in and of itself, not a symptom of something else.

  4. posted by William Womack on

    I was 2 for 3 on this one, looks like I live to hoard another day. (I mean, chronically disorganize…;)

    I’ve been going through “Getting Things Done”, and it has been working wonders on my clutter and disorganization. Highly recommended.

    Awesome Post!

  5. posted by Rebecca on

    I also feel like I might be a little to close to meeting the definition of “hoarder”, especially if it’s seen as a spectral disorder. I mean, I can see my floors, there aren’t dead animals buried under any of my piles, and I can locate things relatively easily, so I have that going for me. ::sigh::

    Anyway, while we’re on the topic of spectral disorders, perhaps we should consider “Affluenza” to be on the spectrum with hoarding…

  6. posted by Ursula on

    My mother is an undiagnosed hoarder. She is also a recovering alcoholic- has been for over 20 years, after nearly 40 years of drinking. Her hoarding behavior has gotten worse over the years, as has her depression. It began with a overstuffed closet and a refrigerator/freezer with dangerously expired food. In response to her, both my sister and I have gone to the other end of the spectrum. My sister has gone to the extreme and is quite the minimalist. I am not as “bad,” but am definitely acutely aware of our potential tendency to inherit the disorder, so I’m aware of clutter and holding onto things too long. This leads me to the question: Does anyone else believe or has there been documentation to show that hoarding can be inherited? Ursula

  7. posted by Kathryn Fenner on

    @Ursula–FWIW, I struggle with using shopping as a mood elevator and then trying to be frugal with the results of over-shopping, or overeating likewise. My mother does exactly the same thing, although she is a bit better about purging her over-purchases. We have both been treated for chronic mild depression and anxiety. We both have trouble putting the clip on the chip bag or leaving chocolates in the box. Is it heredity or environment? My grandmother was much more severely depressed than either of us but between Type 2 diabetes and lack of discretionary funds, and possibly simply better self-control/more strict socialization never had the issues her daughter and granddaughter do with overconsumption….

  8. posted by Stormbringer on

    I used to consider it with the technical term, “nuts”. My wife works at a program that is attended by retarded adults (don’t get PC on me, that “R” word is in the organization’s name). The father of one of the clients endangers his son by taking things away from him and keeping them for himself. Also, he keeps his car so full of junk that he can barely see to drive and there is barely room for a second person. From what I am told about other things this father has done, I would agree, in this case, with Fred E’s thought that this guy’s hoarding is, indeed, a symptom of other disorders.

  9. posted by sjwilde on

    The link to the DSM leads you to a link about the rationale for having this as a separate diagnosis.

  10. posted by NoDSM4Me on

    “…is currently under review…” – lol, it’s funny you used the words under review there., the DSM doesn’t actually base any thing they put in it off any statistical or diagnostic findings. It’s actually all just option. Crazy enough the psychiatrists meet up and raise their hands to vote in or out a disorder to be included in the book. If they think (totally option) it should be included he/she just raises their hand and their vote is cast. How this book is allowed to even use the title that includes the words statistical or diagnostic let alone allowed to be used as an authority on anything is beyond me. Get 5 people together and get them to agree on something and your bond to get some wacky stuff. The book is just rubbish!

  11. posted by Linda on

    What I just don’t get is…. why didn’t people have this 100 years ago? (as in: how can it be that these ‘diseases’ just pop out like that?)

    The same with adhd, gluten intolerance, all those ‘new’ diseases that we face nowadays..

  12. posted by Beverly Wade on

    You might be interested in a new information website on compulsive hoarding – http://www.compulsive-hoarding.org

    This is a comprehensive resource of up-to-date information about compulsive hoarding, its diagnosis, research, treatment and the available support. You’ll also find FAQs, tests and the latest views on this disabling illness.

    As declutterers in the UK, Beverly Wade and Chrystine Bennett of Cluttergone have worked with over 200 individual declutter clients, some of whom are hoarders. They have developed the website for sufferers of compulsive hoarding, their friends, families and anyone with an interest in the subject.

    We hope you find the site useful.

  13. posted by Erin Doland on

    @Linda — The disorders you name aren’t new, they’re just now being named. For example, when I was born, my parents were told that I was one of 12 people on the planet with my skin disorder. Then, about 20 years ago, when the faulty gene was discovered by the human genome project (it was one of the first three to be discovered), scientists found that my disorder was actually one of five disorders. There were five different disorders in the medical books that were actually all the same thing, just with differently expressed symptoms. Now doctors know that there are about 2,500 people with my skin disorder alive right now. It’s called something different than when I was diagnosed, but the treatment, research, and information about it are vastly improved. As we learn more about the human body and genetics, we “discover” new things all the time. The inflictions were always there, we simply didn’t understand them.

  14. posted by Vanessa on

    To my understanding, hoarding is generally a symptom of obsessive compulsive PERSONALITY disorder (not OCD). But I think it’s interesting that it could stand alone as its own disorder.

  15. posted by gypsy packer on

    @Linda–in poor areas, and/or during the Depression, hoarding was a survival mechanism rather than a disorder. People multitasked everything, multiple times if at all possible. When I was out of work, what looked like hoarding actually was the collection of used and antique furniture parts off garbage piles, which were kept until I could find a piece of broken furniture to repair and sell. Once employed, the antique parts fetched a nice price at auction. But, lordy, it was one cluttered and ugly sight while it lasted.

    I’ve seen, over and over, one thing that is a precursor of senile dementia and/or hoarding–the storage of every darned plastic bowl and/or bag the hoarder can acquire. I work for one man with early-onset diabetic Alzheimers family history–the plastic has to be smuggled out to the recycler, on tiptoe, while he’s asleep.

  16. posted by Cathy on

    I worked with an animal rescue organization that helped out a man who was compulsively hoarding animals. It was pathetic how many people had decided before they even met him that he was just a bad person, and not ill. He was a VERY good man with a big heart who was not able to control himself.

    Sadly, finding homes for the 400+ animals we took from his house was not the hard part – getting him into a treatment program was. HE was willing to seek help after we spent some time with him, but _nobody_ was willing to give us the financial aid to get him some help.

    We pulled it together mostly out of our own pockets (after paying to get the animals vetted!!) eventually, but the whole situation made me sad and a little more jaded towards people in general.

  17. posted by Katie on

    The magic words are “safety of self and others”. That will give social service and public safety people the green light to intervene.

    Yes, it is bad whatchacallit-ology, as previous poster points out, like calling talking to yourself the disorder instead of schizophrenia. But, the DSM, like it or not, is most often “The Compendium of
    Codes for which Care May Be Authorized” and this finagling with the categories helps fix a hole in the social safety net.

  18. posted by Jill on

    Very good post.

  19. posted by steph on

    After a teary trip to my therapist yesterday and reading this article, I see that it’s best to confront my husband about his hoarding problem. I can deal with some clutter (we have a nine-month-old), but I can’t handle feeling like my son cannot safely crawl around the house.

  20. posted by gb on

    Just the other day I thought this should be a separate
    diagnosis. It is a pathology. All over the media and outside our doors is snow, lots of it. We see it, name it and try to do something about it–shovel,etc. Hoarders do not see anything wrong. Unless they acknowledge it you can’t help them. Clean up and they do it again. Ursula–yes it is hereditary–that is not a 100% answer, but I speak from my unfortunate experience. Uncles, niece, parents, sibling. This illness is all of the above: a spectrum, separate.
    Some of my friends try to understand but you can’t unless you actually see a “house” in totally neglected condition. This catastrophe is what I am facing now.

  21. posted by cris on

    @Ursula and gb – I also think it has to be hereditary, also from personal experience, my mom, my brother, my nephew (he is only 7!), and of course myself.
    Reading all your entrys made me think a lot…

  22. posted by Alison on

    @Ursula, gb, cris – I would hesitate to think that “Hoarding Disorder” is hereditary. An underlying disorder that CAUSES the hoarding behaviour may be hereditary, but not “Hoarding Disorder” as a stand-alone disorder.

    More likely (in my opinion, at least) it is a learned and repeated behaviour that is then continued through multiple generations.

  23. posted by Jesse Edsell-Vetter on

    As a case manager and trainer who specializes in working with those suffering from compulsive hoarding, I cannot stress how important a separate classification in the upcoming DSM is. There is clear research evidence to show that hoarding should be classified as a separate diagnosis and to show that there is a strong genetic component as well. In particular, the brain function for those with hoarding is different than people without hoarding – especially in the front part of the brain where memory and decision making occur.

    In order to manage their hoarding, individuals must not only learn to separate out the emotional connections to items but they must also learn skills such as sorting, discarding and organizing. Without assistance in learning these skills, the individual will not be able to limit acquiring and manage their possessions.

    A separate classification will also allow those who suffer from hoarding to better access specific cognative behavioral therapy (CBT) and other critical support resources that assist them in managing their clutter successfully over the long term.

  24. posted by Erin Lane on

    Hoarding should stand on its own, for the simple reason that that is how it often affects people. I am treating a woman who is a CPA. She speaks well, she functions, she appears normal. BUT she hoards. She owns three houses but has to live at her office b/c all 3 houses are so full of junk you can no longer open the door. She has over 3 storage sheds that she admits to. She even wanted to store some things in my garage that she trash picked on the way to our appointment. She pays all her bills so no one bothers her. But this disease controls her life and prevents her from having any other activity other than work. Is that not its own disease deserving of its own discrete diagnosis?

  25. posted by Sarah on

    I feel like hoarding should stand on its own as a disorder. It obviously takes its toll on everyone involved. Many people made valid points in the fact it will clear up a lot of gray area and get those help who truly need it.
    I’m also curious about the debate as to whether or not it’s exclusively a symptom of other disorders. Could it not be that hoarding causes other things like anxiety or depression, but we think it the other way around because we are more familiar with the symptoms of the other disorders?

    Also, I definitely do not agree with the post saying that the DSM is a book full of options casually voted upon from a few psychologists. Firstly, you just don’t cast a vote, you actually have to prove your case for the diagnosis to be considered. In proving your case, you develop a standardization of the diagnosis. This comes from hundreds of patient cases from not one, but many different psychologists and professionals. They take a look at this data collected, and make an analysis from that. Plus, there are accepted standard tests that psychologists use (beck’s depression scale,MMPI-II, etc) that help evaluate norms to establish what is not considered normal and what needs to be included in the DSM.

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